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Rhombencephalomyelitis due to possible paraneoplastic syndrome associated with Hodgkin’s lymphoma
  1. Ashraf Valappil1,
  2. Ragesh Radhakrishnan Nair2,
  3. Sudha Madhusoodhanan3 and
  4. Anoop Narendran4
  1. 1Neurology, Aster MIMS, Calicut, India
  2. 2Hemato-Oncology, Meitra Hospital, Kozhikode, Kerala, India
  3. 3Pathology, Meitra Hospital, Kozhikode, Kerala, India
  4. 4Neuroscience, Meitra Hospital, Kozhikode, Kerala, India
  1. Correspondence to Dr Ashraf Valappil; drvvashraf{at}hotmail.com

Abstract

We report a unique case of rhombencephalomyelitis with unclear aetiology, diagnosed with Hodgkin’s lymphoma (HL) on follow-up.

A woman in her 50s was presented with gait difficulty, dysarthria, left Horner’s syndrome and left trigeminal sensory loss. MRI of the brain revealed an enhanced T2 and fluid attenuated inversion recovery hyperintense lesion at the cervico-medullary junction, suggesting rhombencephalomyelitis. The initial differential diagnosis included demyelination, other inflammatory conditions like sarcoidosis, Behcet’s disease and paraneoplastic syndrome. Cerebrospinal fluid analysis, serum myelin oligodendrocyte glycoprotein, neuromyelitis optica antibodies, vasculitis work-up, onconeural antibody panel and whole-body fluorodeoxyglucose-positron emission tomography scan were all unrevealing, and she was kept under close follow-up. After 18 months, she developed a prolonged fever and was diagnosed with HL. Rhombencephalomyelitis as a HL-associated paraneoplastic syndrome has not been reported in the literature. This case report highlights the importance of serial screening for occult malignancy in patients with suspected paraneoplastic syndrome.

  • Brain stem / cerebellum
  • Neuroimaging
  • Immunology
  • Screening (oncology)

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Footnotes

  • Contributors AV admitted the patient and wrote the manuscript. RRN admitted and worked up and treated the patient after the diagnosis of lymphoma. Did editing of manuscript. SM reported the histopathology specimen and did the editing of manuscript. AN prepared the figures and did the final editing of manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Case reports provide a valuable learning resource for the scientific community and can indicate areas of interest for future research. They should not be used in isolation to guide treatment choices or public health policy.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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